Akaishi Rina, Yamada Takahiro, Morikawa Mamoru, Nishida Ryutaro, Minakami Hisanori
Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
BMJ Open. 2014 Apr 19;4(4):e004870. doi: 10.1136/bmjopen-2014-004870.
Some women with isolated gestational proteinuria (IGP) later develop hypertension and are diagnosed with pre-eclampsia (PE). This study was performed to determine whether clinical features of such proteinuria preceding PE (P-PE) differ from those of other PE (O-PE).
Retrospective observational study after approval of the institutional review board of ethics.
A single university hospital. Proteinuria was defined as a protein-to-creatinine ratio (mg/mg; P/Cr) of ≥0.27 in the spot urine specimen. IGP was defined as proteinuria in the absence of hypertension. P-PE was defined as PE in which proteinuria preceded hypertension by more than 2 days.
All of 10 and 18 consecutive women with P-PE and O-PE, respectively, who gave birth between January 2008 and August 2013.
Proteinuria appeared earlier (at 30.2±3.0 vs 35.3±4.3 weeks, p=0.001), the P/Cr level was greater at birth (7.28±2.14 vs 3.19±2.49, p<0.001), net maternal weight gain during the last antenatal 1 week was greater (3.1±1.8 vs 1.3±1.7 kg, p=0.023) and length of pregnancy was shorter (32.5±1.9 vs 36.1±3.6 weeks, p=0.001) in women with P-PE than in O-PE. The duration of IGP was 10.0±5.9 days (range 3-20), and the time interval until delivery after diagnosis of PE was 6.1±8.2 days (range 0-23) in 10 women with P-PE. The P/Cr levels at birth were significantly inversely correlated with the antenatal lowest antithrombin activity and fibrinogen levels among the 28 women with PE.
Women with P-PE were likely to exhibit greater proteinuria in the urine, greater water retention in the interstitial space and more enhanced coagulation-fibrinolysis, thus suggesting that they may constitute a more severe form of PE than women with O-PE do.
一些单纯妊娠蛋白尿（IGP）的女性后来会发展为高血压并被诊断为子痫前期（PE）。本研究旨在确定子痫前期前蛋白尿（P-PE）的临床特征是否与其他子痫前期（O-PE）不同。
经机构伦理审查委员会批准后的回顾性观察研究。
一家大学医院。蛋白尿定义为随机尿标本中蛋白与肌酐比值（mg/mg；P/Cr）≥0.27。IGP定义为无高血压的蛋白尿。P-PE定义为蛋白尿先于高血压出现超过2天的子痫前期。
分别为2008年1月至2013年8月期间分娩的10例连续的P-PE女性和18例连续的O-PE女性。
P-PE组蛋白尿出现更早（30.2±3.0周对35.3±4.3周，p = 0.001），出生时P/Cr水平更高（7.28±2.14对3.19±2.49，p < 0.001），产前最后1周母体净体重增加更多（3.1±1.8对1.3±1.7kg，p = 0.023），妊娠时长更短（32.5±1.9对36.1±3.6周，p = 0.001）。10例P-PE女性的IGP持续时间为10.0±5.9天（范围3 - 20天），诊断为子痫前期后至分娩的时间间隔为6.1±8.2天（范围0 - 23天）。28例子痫前期女性中，出生时的P/Cr水平与产前最低抗凝血酶活性和纤维蛋白原水平显著负相关。
P-PE女性尿液中蛋白尿可能更严重，组织间隙水潴留更明显，凝血 - 纤溶更活跃，因此提示她们可能比O-PE女性构成更严重的子痫前期形式。
